This is a case report of a 62 year old female with a recently treated laceration involving the FDS and FDP of the left hand who presented with right upper arm pain six weeks following her injury. Radiographs obtained 3 weeks later demonstrate no obvious abnormality. MRI performed for persistent pain 3 weeks later demonstrates marrow edema and periosteal reaction consistent with stress fracture. This was confirmed with repeat radiographs and a CT scan. The patient was treated conservatively with successful healing and absence of pain 23 weeks from her initial injury.
This case represents the first known report of a longitudinal stress fracture of the upper extremity. These injuries have been classically seen in the lower extremity with the majority presenting in the tibia. This patient represents one of two groups at risk for this injury: young athletes and the osteoporotic older individual. As the marrow edema on MRI may be misleading, CT scan and serial radiographs are the imaging modalities of choice. Activity modification is the mainstay of treatment.